US Medicare IRMAA surcharge raises premiums for high‑income couples

The Income‑Related Monthly Adjustment Amount (IRMAA) adds a surcharge to Medicare Part B and Part D premiums for beneficiaries with higher incomes. The surcharge is calculated from a couple’s modified adjusted gross income (MAGI) reported two years earlier. If a married pair filing jointly exceeds the MAGI threshold of $218,000, each spouse pays the full surcharge; the amount is not split between partners.

For 2026 the standard Part B premium is $202.90 per person when MAGI is at or below $218,000. Above that level the premium rises to $284.10 per person, resulting in nearly $2,000 extra household cost. Additional surcharge tiers increase the premium up to $689.90 for the highest‑income brackets. Examples such as a Roth IRA conversion demonstrate how financial moves can trigger higher premiums. Beneficiaries are advised to project their MAGI before year‑end and may request a reconsideration of the surcharge if circumstances change.

The IRMAA rule, mandated by the Social Security Administration under Section 1839(i) of the Social Security Act, applies to about 8 % of Part B beneficiaries nationwide.